Employers as moral arbiters

Years ago, a good friend from medical school was complaining to me about her health insurance.  Specifically, she was lamenting its lack of coverage for birth control.  At the time she was a resident at a major medical center around our nation’s capital, one which happens to be a Catholic institution.  She didn’t choose to do her residency there because of its religious affiliation, but because of its reputation for excellence, just as I didn’t choose where to do my fellowship in New York because of its history as a Jewish institution.  As far as I am aware, the only way the institution’s Roman Catholic affiliation manifested itself in her work or life as an employee was to hinder her ability to have non-procreative sex.

Not that it should matter, but I may as well mention that my friend was married.  And Hindu.

Now, I suppose one could argue that a truly optimally-informed person would have considered all the ramifications of her potential employers’ policies and histories and so forth, and composed her residency rank list accordingly.  If one made that argument, it would follow that only potential employees who were willing to accept Catholic doctrine with regard not just to the way they functioned within the workplace (where it seems somewhat more reasonable to me) but also to the conduct of their personal lives to a certain degree as well need apply for jobs.  They wouldn’t have to be Catholic, but would have to accept the Catholic Church’s beliefs about whether you should be having sex without the potential for conception.  This would apply not only to employees of the Catholic Church as an explicitly religious institution (people employed directly by some diocese or church, for example), but also those who work for Catholic hospitals or universities — the janitor at Holy Family Hospital and the anthropology professor at Notre Dame, just the same as Father O’Donnell at Sacred Heart Parish.

While not outright religious discrimination, this is certainly religious interference.  While the Roman Catholic church may believe that founding hospitals, universities and charities is an act of faith (for which it is to be sincerely appreciated and commended), by this point in the history of most of those institutions the religious nature of their founding is incidental to the professional lives of many (most?) of their employees.  Working as a physician in a Catholic institution may in some way contribute to the Church’s worldwide mission, but her work there was strictly secular and professional.  (Even though I am somewhat religious myself and to a certain extent chose my vocation because of a desire to do good works, I don’t really believe my work as a doctor fulfills Christ’s injunction to comfort the sick.  Somehow it seems to cancel it out as charitable work if you get paid well to do it.)

When the Roman Catholic church asks to be exempted from federal regulations requiring insurers to provide contraceptives to women as part of their coverage, they are asking for the power to exert the force of their doctrine into the lives of people who have not empowered them to do so.  They can propound whatever they want about their beliefs to whoever wishes to hear it.  But they do not have the right to dictate or inhibit the private, personal choices of people whose only relationship with them is as secular employees.  The President should respectfully ignore their request.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. I heard this on the radio this morning, and my first thought was, I hope Russell Saunders writes about this.

    I’m torn, though, and not sure I agree (although I’m not quite sure I disagree). The church isn’t really telling people what they can and can’t do, but are refusing to be complicit in those people’s choices. That does affect the people, of course, but the church isn’t saying “you’ll be disciplined if you have non-procreative sex.”

    There are, on the other hand, conservative protestant colleges that do impose off-campus lifestyle restrictions on their faculty. Thou shalt not drink, etc. I once had a professor who was fired from such a college for divorcing his wife. I think that’s legitimate, if unpleasant, but in part because those are small colleges where the faculty understand that their work is not “strictly secular,” even if they are teaching chemistry.

    Somewhere along the scale from small private college to large private university to private but almost-effectively-public hospital the balance may tip to your side of the scale. Maybe. It’s awfully hard to determine just where it tips, though, and that makes me hesitant.

    • Well, firstly I’m kind of chuffed that you thought of me when you heard the report. (It’s probably the same report that reminded me I had planned to write about this.)

      While I agree that the RCC isn’t explicitly disciplining employees who engage in non-procreative sex, it’s certainly making it more onerous. Paying out of pocket for contraception may not be a major burden to some employees, but for many it might well be. If you consider that the insurers might further balk at paying for doctor’s visits whereby the contraceptives are prescribed and monitored, then costs becomes even more prohibitive. The church is undeniably creating a disincentive, even if it doesn’t rise to the level of outright discipline.

      I agree that it’s a bit hard to make a blanket statement that fits tidily for all questions of this nature. I think an important factor to consider is how explicit or predominant is the religious nature of the institution in question. Presumably the conservative protestant colleges you mention make their religious teachings and expectations central to their recruitment and message. I would imagine that many even make their expectations for students and employees (especially ones like professors who are expected to set some kind of example) clear in some sort of statement that they are expected to sign. While I’d never want to work at such an institution in a gajillion years, I can accept their right to behave in a manner like you describe.

      But for institutions like Notre Dame or Georgetown (to name but two) with their vast apparatuses that are tangentially related to the religious charter of the institutions at most, it seems very hard to justify this level of intrusion. To what degree is a research scientist at, say, the Center for Aquatic Conservation bound by the strictures of the Catholic Church? Hardly any, I would argue.

      • I think it’s a hard case, but we’re thinking along the same lines of analysis as to what are the relevant factors in making the decision.

  2. I have friends/family who have had rough, really rough, childbirths. As in, we were pacing around the floor wondering what would happen if the mother died and who would do what for the next month or year.

    Thankfully, the moms all pulled through.

    One case took place at a Catholic Hospital and, as it turned out, mom and dad figured that they’d never go through this again and asked to have mom’s tubes tied while they were going to be in there doing a caesarian anyway. Of course the answer came “Nope”.

    With that said, I’m glad the hospital was there anyway. They did a good job keeping the mom alive.

    Now I compare to Massachusetts Adoption Services and how they got shut down.

    Let’s say that it comes to a head-to-head to tell the hospitals that they need to stop doing this crap. It seems as likely to me that they’ll just shrug and walk away as say “gee, we really like funding”.

    How likely is it that the vacuum will be filled without much impact upon health care provision (after a rocky year or three), assuming that the church just shrugs again?

    • If the provision of contraception is so anathema to the Catholic Church that they would rather shut down a hospital than provide it, then I would personally find their priorities… troubling. Thankfully, I seriously doubt that this would be the outcome, given precedent.

      • The problem with the Church’s position is that (for example) The Pill is merely a chemical compound which can have no moral quality, good or bad. It’s akin to blaming gunpowder for war. The sin in question here is having non-procreative sex. That, obviously, is none of an employer’s business.

      • The flip side is the question of whether “we” (for whatever definition of “we” you want to use) would rather have the hospital shut down than allow it to not provide contraception as part of its health care plan.

      • Russel:

        Why do you find it troubling that folks might actually carry out/follow their value system instead of just talking about it?

      • I would find it troubling if the priorities of the Catholic Church value the prevention of women using contraception more than keeping a hospital open. That seems downright nutty to me. But if that were to be their choice, it is indeed their choice to make.

        • Uh-oh, Dr. Saunders. Trying to be polite, civil, and on-topic. Is the destiny of my comments, nonetheless, the big cyber shredder in the sky? Say it ain’t so, Doc. This is a great thread you’ve put up and it’s fun to participate in this discussion. If that’s no longer possible, please let me know. It’s your thread and you can do whatever you want with whomever you want regarding the acceptability of their comments and remarks.

          • I’ve gone through your comments this round, and most of them (mirabile dictu) actually seem on-topic. (If you’re curious, it was your nuclear holocaust comment that prompted the ban.) Keep your comments on-topic and civil, and I’ll keep the ban lifted.

          • Many thanks, Dr. Saunders–you’ve made my day! See, you can teach an old dog new tricks or at least teach them to see how discourteous it is to the Thread Bearer and commenters to flippantly toss aside the topic of discussion and just selfishly inject something entirely different into the ongoing discourse.

            Hey, I even said we may become friends or more likely, you may not even harbor homicidal fantasies in how to effectively and in the most painful manner possible, kill this Heidegger lunatic.

            Oh, over in Will’s thread I was in a discussion about composing the Trivia puzzles and how they could easily go off the cliff of esotericism given that they are constructed by the moderator. I started to give him an example but then realized it was not a good example at all–it was not hopelessly esoteric but quite solvable. I’d love to hear your reaction if you happen to have a free moment to take a quick glance at it.

            Many thanks, Dr. Saunders.

  3. One thing that seems relevant to me is how very young this particular sensibility seems.

    Griswold v. Connecticut was only decided in 1965. Eisenstadt v. Baird? 1972!

    • I respectfully dissent. The newness of a sensibility seems unrelated to its rightness to me. As another example, Lawrence v. Texas was only decided in 2003. Does the relative novelty of the decision mean that it might be just for people like me to go to jail for our private sexual behavior? I would argue that it was never just, and the newness of the Court’s decision is irrelevant to that question.

      • Birth control in one form or another has been around for a long time in the form of emetics, teas, and devices.

        • Burt–agents that induce vomiting can cause an abortion? I never knew that. I don’t even see how it’s possible but if it’s coming from you, I’m sure it’s true. Interesting. Could RU-486 have other uses other than aborting an embryo? Or, I should say, aborting the possibility of an embryo?

      • The relative novelty should be taken into consideration, certainly.

        If the Institution has had a particular outlook for, oh, 600 years and has set up Hospitals that have this particular outlook, it seems weird to say “no, you have to start providing services you’ve never provided before.”

        The contrast to Lawrence v. Texas is different insofar as that was a case that told the government to *STOP* enforcing a law that it didn’t enforce against heterosexual couples. The government was asked to engage in restraint.

        This is asking an Institution to start doing things (providing birth control and, presumably, tubal ligations) that it has never before done.

        • Oh, we’re not talking about asking Hospitals to provide tubal ligations but just asking their health care plans to provide birth control?

          Well, surely there’s no harm in letting the camel’s nose in the tent…

          • Which is another way of invoking the slippery slope argument. I would counter that each individual question should be argued on its own, without gesturing toward possibilities that may or may not come to pass.

          • Russell:

            It may seem logically convenient to argue issues separately but in the real world issues tend to be connected and don’t exist singularly in a vacuum.

        • Fair enough, as far as it goes. But the government isn’t forcing doctors at Mercy Hospital to perform tubal ligations or its pharmacy to stop Ortho-Novum. It’s forcing the Catholic Church, as an employer of innumerable workers who do not subscribe to its doctrines and who function in wholly secular capacities, to cover legitimate healthcare costs.

          • I don’t know how I feel about first-dollar coverage for absolutely everything.

            I got into an argument over whether viagra should be covered by insurance and the counter-argument came “shouldn’t people who want to have sex have the right to have sex?”

            It seems to me to be a hair more complicated than that in practice.

            Yaz costs $60/month without insurance. Rubbers cost… I don’t know how much rubbers cost. They cost a *LOT* in the early 90’s, though. Are rubbers covered (HA!) by insurance?

          • I’m inclined to be sympathetic to your view, Russell, but I’m probably closer to James’s opinion (expressed above). Still, I’m having a bit of trouble with this:

            “It’s forcing the Catholic Church, as an employer of innumerable workers who do not subscribe to its doctrines and who function in wholly secular capacities, to cover legitimate healthcare costs.”

            This would seem like a pretty good test for determining when employers would have to give in (for lack of a better term), but I question how easily this could be determined.

            I’m not that familiar with the specifics of Roman Catholic doctrine as it applies to hospitals, but I could quite easily imagine a religious group seeing the role of doctors in their hospital not being “wholly secular capacities”. If the institution views running such institutions as a part of living their faith, then it really isn’t a secular endeavour – even if it is for the specific employee.

          • I don’t really think it’s up to the employer to determine the motivations behind its employees’ actions.

            There’s nothing explicitly religious about practicing medicine. The medical care I deliver at a religiously-sponsored hospital should be indistinguishable from the care I deliver at a secular one; New York Presbyterian vs NYU Medical Center, it should make no difference. Ditto for running a CT scanner, or spinning a centrifuge. Perhaps the Church believes it’s all part of a religious call to service, but I imagine it would find many strident objectors if it were to count employees as adherents to its faith. The same applies to research scientists working at Georgetown, for example. Pace the Jesuits, but they aren’t really in a position to ascribe the actions of their employees to a religious pursuit. (See JG New’s comment below.)

          • I’m not arguing that employers (the religious institutions) are determining the motivations of the employees. The motivations of the staff are completely irrelevant to this; it’s the motivation of the employers.

            Working with doctors (or nurses, scientists, professors, custodial staff, or whomever) to provide good works – basically, helping make the good works possible – can be an act of faith. It is not about ascribing the actions of the employees to a religious pursuit, but their own actions. Yes, such employers will recognize the work of their employees as means towards an end that is, for the employer, intrinsically linked to thier faith, but that is something different.

            Many people of faith believe that divine results can be realized through the work of those who are not part of the faith, and actively attempt to engage in interfaith (or inter-non-faith) activities. It is difficult to disentangle all this. It’s not as simple as saying that since medicine is medicine, there’s not aspect of faith to its administration.

          • The only question that seems germane to me is the relationship between the employee and the Roman Catholic Church. If the relationship is strictly that of employer/employee, indistinguishable between the employer/employee relationships at an equivalent secular institution, then the RCC has no special claims with regard to the private moral behaviors of its employees.

            It is wholly irrelevant to me what the overarching goals of the Church are for founding hospitals or universities. I’m glad they do it, since I think it’s good for humanity. But their goals don’t give them permission to place religious restrictions on the behavior of their employees, who are functioning in a secular matter for purposes that are (for them) non-religious.

        • If the Institution has had a particular outlook for, oh, 600 years and has set up Hospitals that have this particular outlook, it seems weird to say “no, you have to start providing services you’ve never provided before.”

          Which is all well and good as far as that goes, but that’s not necessarily what’s happening here. After all, it the Catholic Charities adoption cases, the adoption agency had been placing children with gay couples for years. It was only after gay marriage became legal in Massachusetts that the higher ups decided to stop providing that service. Do people who work for catholic churches lack access to insured reproductive health care as a rule? Or is the Church asking for the government’s blessing as they rescind existing coverage?

          • The only time it should ever matter is when abortion is the issue: whether advocated, recommended, or performed. Naturally, abortions would never be performed, for any reason, at a Catholic hospital. But let’s say you a professor at Notre Dame who militantly carries the banner for a women’s “reproductive rights” whether it’s aborting a fetus from conception right up to time of delivery? Does a Catholic university have a right to fire such an ideologue?

  4. When the Roman Catholic church asks to be exempted from federal regulations requiring insurers to provide contraceptives to women as part of their coverage, they are asking for the power to exert the force of their doctrine into the lives of people who have not empowered them to do so.

    There is this side, yes, but there’s also the Catholic Church’s legitimate interest in not being forced to materially cooperate in actions (contraception, sterilization) the Church deems immoral.

    I’m curious to see how the Catholic Church ultimately responds to these new requirements. The Diocese of St. Petersburg has threatened to no longer provide health insurance to its over 2000 employees if the Church doesn’t receive a religious exemption. Instead, it would give employees a stipend for them to purchase their own insurance so that the diocese isn’t directly involved with funding the offending services. Whether this will be a trend I don’t know. Other diocese may tolerate the requirements while communicating to employees the expectation that they not use their coverage for services considered immoral by the Catholic faith.

    • I concur that, acting as Church, it should not be forced to materially cooperate with what it deems immoral.

      However, to return to two very easy examples, look at all the disparate academic, legal, medical, research, etc. institutions affiliated with Notre Dame or Georgetown. In what way is the Church asserting itself as a religious entity when maintaining them? How is it functioning in any way other than as an employer, secular in all but name? The more diffuse its mission (and, again, I think it’s wonderful that those universities sponsor the vast number of institutions that they do), the weaker its claim to have authority to proscribe immoral actions on the part of its employees.

      • I spent a couple of decades as a non-Catholic science faculty member at a large Jesuit university, and I can tell you how they’d answer that. They’d say that the furthering of human knowledge, the illumination of God’s creation through humanity’s exploration, ad majorum Dei gloriam, is an essential mission of the Church. The Jesuits and their universities have a long tradition of scholarship.

        You might put that down to mission-statement-type pablum, and I would not necessarily disagree with you – but there is a coherent rationale.

        What tore it for me was when the Science Library sponsored an exhibition of 17th-century scientific treatises by Jesuits. Mostly astronomers very learnedly refuting Galileo. That’s when I put the portrait of Oliver Cromwell up in my office.

        • Oh PLEASE JGNew, anyone but Cromwell. Talk about ruffling some feathers–in the eyes of the Irish, that would be worse than–okay, maybe the equivalence of–a portrait of Hitler at Brandeis!

  5. In 48 out of 50 states, and the District of Columbia, an employer may impose workplace discipline on an employee for expressing, during personal time, a political viewpoint at variance with that of the employer.

    Sounds awful — if my employer is a Republican and I’m a Democrat, it seems dreadfully unfair that I should have to fear losing my job. But consider that a prominent employee might express the political viewpoint of neo-Nazis, and the employer may be concerned that the will cause its customer to boycott. An employer who isn’t all that concerned about “D versus R” might reasonably find Nazism too big a pill to swallow.

    But in two states (Washington and California) there are statutory guarantees against adverse employment action taken against employees for their off-duty political activities. Those states have made the choice to regulate and limit the employer’s discretion, feeling political expression is more important than employer autonomy.

    This is not quite the same thing as not offering birth control in a health care package, and deciding whether or not it is appropriate for the government to mandate this against the employer’s wishes. But it’s certainly in the same neighborhood.

    Or consider an employer who fires or refuses to hire employees who smoke, a practice which is legal in 21 states (e.g., Michigan) but prohibited in 29 (e.g., Wisconsin). Is Wisconsin’s law prohibiting this employment practice appropriate, or does Michigan have it right that the employer ought to be able — justified perhaps by the expense of health insurance — to regulate the private, legal, off-duty behavior of its employees?

      • This does not make me particularly exercised, though I do think it’s a bit silly and futile. By living on campus (and thus the University’s property), residents agree (implicitly or explicitly) to abide by a (presumably stipulated) code of conduct.

    • Thanks for weighing in, Burt.

      While I would understand why an employer might want to jettison an employee who marches with an “Up with NAMBLA” flag, I recoil from the notion that employers have free reign to fire employees for private political expression. I assume there’s variation between states as to how broad this power is?

      I also object to employers being able to fire employees who smoke. While I can understand why employers might want to limit their costs by shedding workers more likely to have higher healthcare expenses, I still value personal autonomy far too much to side with Michigan.

      • I assume there’s variation between states as to how broad this power is?

        Not really. Each state has a set of statutes that carve exceptions out of the “employment-at-will” doctrine that is the backdrop of employment relationships governed neither by negotiated contract nor collective bargaining. All of the states do at least as much as Federal law and prohibit discrimination on race, national origin, religion, gender, and age over 40. Some go further for things like marital status, sexual preference, veteran status, things like that. California and Washington are the only ones that protect off-duty political activity to my knowledge.

        In practice, there are really not a lot of “D versus R” sorts of termiantions of which I’ve been made aware because people as a general rule have at least that much common sense. (There are, of course, obnoxious exceptions to this rule of thumb.)

          • Mostly righteous ones. Employers have a lot of latitude.

            Looking at my current docket I see a handful of pregnancy discrimination cases, several retaliation/whistleblower cases, and to Tod Kelly’s amazement, a quid pro quo sexual harassment case. I actually had a second quid pro quo case recently, but my client elected for her own reasons to not prosecute it, much to my disappointment.

  6. This strikes me as a really tough issue, for many of the reasons discussed here. It’s one thing to allow employees to do this or that, it’s another thing to have to pay for it. At the same time, I know more than one woman that takes birth control for reasons other than pregnancy prevention. It’s not some bizarre thing or an excuse. It’s medical care to alleviate discomfort. And, of course, if you carve out an exception, it will be prescribed for one reason and used for another (Welbutrin falls into this category. You have to tell a doctor “I’m sad” in order to get insurance to pay for it for smoking cessation).

    All in all, this is a reason why it’s so problematic to have employer-based health care.

    • “All in all, this is a reason why it’s so problematic to have employer-based health care.”

      One of many takeaways I took away a while back.

      I think this is the dark edge between mission statements. The Catholic Church, as a religious organization, has a latitude that some other non-religious organizations don’t have. However, because we have employer-provided health care as a norm, the government has a credible interest to defend the right(s) of the individual against the right(s) of the organization.

      Decoupling health insurance from the employer makes this a non-issue.

      • Agreed, for a similar reason;
        Health care shouldn’t be a consumer freebie like a gym membership or skin-in condo that employers give as a privilege.

        If we can’t, as a nation, figure out a way to get the market to offer health care that is universally affordable, then we have a moral obligation to provide it some other way.

        As it is now, whether you receive good health care or whether you are allowed to crawl in the gutter holding your colostomy bag [http://www.usatoday.com/news/nation/2007-02-15-skid-row_x.htm]
        depends entirely on what sort of job you had when you got sick.

  7. It’s worth pointing out here that fertility is:
    1. Not a disease.
    2. A condition that the vast majority of women have for nearly half their lives, and therefore not a good candidate for insurance.

    There simply isn’t any good reason for health insurance to cover birth control. Or normal childbirth expenses. Insurance is for abnormal, unpredictable expenses.

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